Clubs Application

  
     

 

Clubs Quick Application for General Liability Insurance

Club Name
Club Mailing Address
City
State
Zip code
Contact Person
Daytime phone number
Fax number
E-mail Address
Are you an USAS Club Affiliate? Yes No
USAS Club Affiliation number
Current Number of Members
Does your club permit the use of tree stands?
(a premium surcharge will apply) Yes No
Location Schedule
Location 1 Address:(street, city, county, state, zip, or legal description filed with the local courthouse)
   
Location 2 Address:
   
Location 3 Address:
   
Limits of Liability
  Effective Date
  Current Premium
General Liability Limits
 CurrentDesired
 $250,000$250,000
 $500,000$500,000
 $1,000,000$1,000,000
 $2,000,000$2,000,000

This is an application for General Liability Insurance Coverage Only. Other types of insurance are available including liquor liability, property, crime and umbrella insurance. Contact our sales department toll-free at 1-888-839-3118 for more information.

Questions or Comments:




By submitting your application we can provide you with a competitive quote. You are under no obligation to participate in the program.
   
       

 

  

 

  

 
© 2008 Lockton Risk Services, Inc.

USA Shooting Endorsed Property & Casualty Insurance Program Administered by Lockton Risk Services, Inc.
P.O. Box 410679 | Kansas City, MO 64141